Provider Demographics
NPI:1477262723
Name:PHOENIX BEHAVIOR SERVICES ABA LLC
Entity Type:Organization
Organization Name:PHOENIX BEHAVIOR SERVICES ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO TARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-286-1452
Mailing Address - Street 1:13220 SW 271ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8592
Mailing Address - Country:US
Mailing Address - Phone:786-286-1452
Mailing Address - Fax:
Practice Address - Street 1:25001 SW 127TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5834
Practice Address - Country:US
Practice Address - Phone:786-286-1452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty